The battle against HIV and AIDS in Pakistan is winnable. The epidemic can be controlled and reversed. There are documented good examples in country of targeted interventions that have resulted in stopping HIV transmission and reducing HIV prevalence in communities at risk. These examples need to be replicated to avert new infections, help communities at risk protect themselves from the virus and stop the virus from spreading further. This battle against HIV and AIDS will be lost if we deny the presence and spread of HIV in Pakistan and underestimate the consequences it can have if it spills beyond communities at risk into the general population. It can be won if we accept it exists and act fast by focusing on the right front with the right tools and hardware.
In addition to helping those already infected, our primary focus at this stage should be to prevent its further transmission among identified communities that are most at risk. At risk due to behaviours and practices that increase exposure to the virus. There is evidence that in Pakistan, communities of street-based persons injecting drugs, male and female sex workers and communities of Hijras engaged in injecting drug use and/or unprotected sex are most at risk of HIV transmission. Risks of exposure to the virus among these communities can be drastically reduced and minimized by providing these communities with the correct information and tools to protect themselves and associated persons at risk. The HIV virus is transmitted through infected blood, unprotected sex with an infected partner and from an HIV infected mother to her child.
In Pakistan, HIV prevalence is the highest among street-based persons who inject licit (pharmaceutical injections) or illicit (heroin and morphine) drugs compared to other identified high risk groups. Of the estimated half a million chronic opiate/heroin users in Pakistan more than 100,000 have shifted to injecting drugs in the recent past. The National HIV prevalence among this most at risk group is alarmingly above 20 percent and increasing. However, there are cities in Pakistan where above 50 percent of the persons who inject drugs are already infected with HIV. Transmission in this group is high because of sharing of infected syringes among people injecting drugs, the most efficient way of transmission of any blood borne virus like Hepatitis C.
Transmission is high in persons who inject drugs as majority has not heard of HIV and AIDS. Those that have heard of HFV do not know how it is transmitted hence do not know how to protect themselves from the virus. And those that know do not have the resources or means to access or buy sterile syringes or needles to inject safely and protect themselves. Recent reports also indicate that the shift to injecting drugs is happening at an earlier age, which will result in HIV transmission among groups of homeless street children. This is a dangerous trend and will have devastating consequences for young people.
Street-based persons who inject drugs are often considered an isolated community that does not interact with the general population, hence often considered an insignificant vector of HIV infection to the general community. This is incorrect.
First of all over 99 percent are men of which 50 percent are married with an average of four children per family. There is documented evidence in Pakistan of transmission from infected husbands to their wives due to unprotected regular sex and from the infected mothers to new born babies.
There is also an overlap where infection can be transmitted between people who inject drugs and the general commun0ity. This overlap happens in health care facilities accessed both by people who inject drugs and the general community especially where the quality of bio safety measures are inferior, particularly the use of non-sterile injections and/or surgical instruments. In jails where people who inject drugs share infected syringes with jail inmates. Places where sex workers have unprotected sex with people who inject drugs and customers from the general community.
What must and can we do? We can learn from good examples in country, fight the battle against HIV and AIDS and win the battle! A good example to learn from and replicate is the Comprehensive HIV prevention programme for people injecting drugs initiated in 2005 by The Punjab AIDS Control Programme of the Department of Health of the Government of Punjab, supported by the World Bank in a public-private partnership with a national nonprofit organisation in Lahore, Faisalabad, Sargodha and Sialkot.
This scaled up; uninterrupted and consistent service delivery has halted and reversed the prevalence of HIV among communities of street based persons injecting drugs.
This fact has been evidenced, recorded, documented, monitored and evaluated by the National AIDS Control Programme, the World Bank and key UN agencies. As a result the programme is now being expanded to an additional eight cities of Punjab.
In order to block and reverse the epidemic at least 80 percent of the estimated 100,000 street-based persons must have regular access to similar comprehensive HIV prevention services. The national coverage by the end of 2009 will be approximately 28 percent for which services in the Punjab alone account for 22 percent. There is still a gap and an immediate need for an expanded response by scaling up services to reach 80 percent.
Prevention is better than cure. Every rupee spent at this stage will save thousands of lives and save millions of rupees in the future. The battle against HIV and AIDS in Pakistan needs leadership at all levels to seriously engage and commit resources to prevent further transmission, help those already infected and win the battle. Fighting and winning this battle is the responsibility of every Pakistani.
On behalf of civil society, persons already infected with HIV, people who inject drugs and their families we would urge provincial and national leadership in particular parliamentarians and related govt departments to ‘fast track’ the proposed scale up and prevent a highly stigmatized, devastating and complicated disease from affecting communities already crippled by poverty and injustice.
ASHFAQ REHMANI Organizer Youth & Women Empowerment Society